An infusion catheter, such as a peripheral intravenous catheter, is a thin flexible tube that is inserted into a peripheral vein, usually in the bend of the arm of a patient. Once inserted, the infusion catheter is threaded along the peripheral vein with the tip ideally positioned for infusion of fluids where they can be quickly diluted. Peripheral catheters as well as other types of catheters including peripherally inserted central catheters, central venous catheters and Hickman lines can remain in place for extended periods of time within a patient (up to six months). Infusion catheters have been available for many years and are typically used to administer fluids such as parenteral nutrition, chemotherapy, vasopressor (adrenalin-like medications), antibiotics and other hypertonic/caustic solutions. These catheters may also be used for blood draws. The use of such catheters avoids the complications associated with the direct puncture of the central venous circulation system. However, using a peripherally inserted central catheter to administer fluids to a patient is not without its drawbacks.
A common problem with the infusion of solutions into a patient is extravasation. Extravasation is the collection of interstitial fluid such as blood, nutritional fluids or medications into tissue surrounding an infusion site. Fluid escaping into the soft tissues surrounding the infusion site can have adverse effects on the patient. Some of these effects include the forming of blood clots in veins (thrombophlebitis), arterial injury, nerve injury, the compression of blood vessels and nerves and infection.
Extravasation of certain medications can also lead to other injuries commonly referred to as “IV burns.” Leakage of cytotoxic drugs, intravenous nutrition, solutions of calcium, potassium, bicarbonate and even dextrose solutions outside the vein can cause skin necrosis. Other complications may include scarring around tendons, nerves and joints, especially on the dorsum of the hand or in the antecubital region. Extravasation may even cause skin loss above the area of injury and may require skin grafting.
In cancer treatment, accidental extravasation is a feared complication, especially from drugs such as the anthracyclines, mitomycin, vincristine, and vinorelbine, which are examples of vessicant drugs. Vessicant drugs cause tissue destruction upon infiltration. In this context, extravasation is the unintended presence of a vessicant outside the vascular bed or vasculature.
Accidental extravasation has been estimated to occur in up to 6% of all patients receiving chemotherapy. Chemotherapeutic agents, such as the anthracyclines, are especially likely to cause severe tissue damage on extravasation. The tissue injury may not appear for several days or even weeks, but when it appears it may continue to worsen for months, due to drug recycling into adjacent tissue.
The danger of the adverse effects as well as kinks or clogs in the catheter may require catheters to be removed from a patient and reinserted in another location. Furthermore, extravasation may result in longer recovery time, pain and discomfort in patients. Because of the effects caused by extravasation, devices and methods are needed to reduce extravasation caused by the use of infusion.